Managing Stroke Risk in Afib Patients
You may have seen that Afib itself is not a deadly condition. Instead, it is a problem that may lead to increased risk for other much more severe cardiovascular concerns, including five times increased risk of stroke and heart attack. It is, in fact, the management of this stroke risk that we consider to be the primary reason for treating Afib. The risk of stroke in Afib patients is between 1% and 20%, depending on a few other considerations.
But Why Exactly Is Stroke Risk Increased?
Cardiac arrhythmias and Afib specifically create a situation in which the heart cannot pump blood as effectively. The result can be the pooling of blood in specific heart structures. The structure most susceptible to clotting is the left atrial appendage or LAA. This is an outpouching in the upper left quadrant of the heart that serves no discernable purpose. It’s much like the appendix because we don’t need it, and we’re not quite sure why it developed.
Because of the irregular heartbeats, the blood within the LAA is not efficiently pumped out and can stagnate and begin to clot. Eventually, if the clot breaks off, it can travel through the bloodstream and into the brain, where it can cause a stroke. It is estimated that upwards of 1 in 7 strokes are caused by or are related to Afib.
What Can We Do to Mitigate Stroke?
For decades, the gold standard in minimizing stroke risk in Afib patients has been anticoagulant medication. These are easy to prescribe to about 50% of all patients who respond well. However, medication has several downsides, not least of which are the potential side effects. Further, medication does not treat the core of the problem; instead, it works only if the drug is being taken.
The Watchman LAA closure device may be an option for those having trouble with their medication. This device sits snugly over the opening of the left atrial appendage and, within 45 days or so develops a seal through which the blood clots cannot pass. About 96% of patients could get off their anticoagulants within 45 days after the procedure.
Of course, these treatment options must also be employed to improve or eliminate the arrhythmia. This can be achieved using heat or alternately cold therapy as part of cardiac catheter ablation. This is also an exceptionally effective procedure for the adequately chosen patient.
For those patients who can take blood thinners, data has shown that the conjunction of ablation and continuation of oral anticoagulation can reduce the risk of stroke to the same level as a person who has never had Afib.